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A few weeks ago, we had a discussion about targeted therapies and molecular profiling. This week, I'd like to talk about how the concept of individualized care is being put into practice for the treatment of non-small cell lung cancer at Mayo Clinic.
Non-small cell lung cancer has many different subtypes based on genetic mutations. At Mayo Clinic, tissue from lung tumors is analyzed with a tumor assay that can identify over 180 mutations from the 10 oncogenes commonly altered in non-small cell lung cancer. Molecular profiling of each patient's cancer helps the care team recommend tailored treatment for the patient.
The most common mutations identified for non-small cell lung cancer include epidermal growth factor receptor (EGFR), EML4-ALK gene fusion, and the V-Ki-ras2 (KRAS) mutations.
EGFR mutations tend to be more common in women and in people of Asian descent. EGFR mutations are a common finding with patients who have non-small cell lung cancer and have never smoked. The EML4-ALK gene fusion is less common, but also present in patients who have never smoked. The KRAS gene mutations are more commonly found in patients who have a current or past history of smoking.
Targeted therapies for patients with EGFR mutation currently available include gefitinib (Iressa), erlotinib (Tarceva) and cetuximab (Erbitux). The drug crizotinib (Xalkori) is approved for the treatment of non-small cell lung cancer patients with the EML4-ALK fusion. Many additional targeted therapies are currently being studied.
The idea of individualized medicine is to use specific cancer therapy to target the precise mutation in the patient's lung cancer cells with the goal of providing a more effective treatment with fewer toxic effects to the rest of the body. At times, targeted therapy is combined with traditional chemotherapy and/or radiation to optimize results.
For more information and videos on this topic, go to the Biomarker Discovery Program section of the Mayo Clinic Center for Individualized Medicine website.
Follow me on Twitter at @SherylNess1. Join the discussion at #livingwithcancer.
Sheryl M. Ness, R.N.
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Stephanie, if a patient has a KRAS mutation, additional therapies are available, which may include trying a combination of chemotherapy agents. Researchers are actively studying new drugs for patients with KRAS mutations that are available in clinical trials as well.
So am I to understand there is no therapy for KRAS if that is the mutation found.
It is difficult to understand why stopping cancer is such a problem. I know cells mutate but one would have thought modern science would have a clue. The Chemo treatments are horrible and I don't know how much longer I can tolerate the sickness. Perhaps death would be far more humane.
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